This study is a double-blind comparison of buprenorphine (1-4 mg sl daily), a partial opiate agonist, vs. clonidine (0.2 - 0.9 mg po daily), an alpha-2 adrenergic agonist, in the treatment of acute opiate withdrawal. Eighteen patients were randomly assigned to receive one of the 2 medications for 3-5 days, followed by 12-14 days of inactive placebo. Patients were also stratified by degree of opiate dependence, as measured by a cutoff opiate withdrawal score following naloxone challenge (0.4 mg im). Outcome measures included both physiological and psychological signs and symptoms of opiate withdrawal. In addition, an optional subprotocol involved measuring vagal and sympathetic tone as reflected in variations in cardiac interbeat interval (in collaboration with the ARC Vulnerability Section). This study is the first direct, controlled clinical comparison of buprenorphine with a standard treatment for acute opiate withdrawal. Results indicate that buprenorphine is at least as effective as clonidine for short-term opiate detoxification.